ENGAGEMENT WITH THE PRIVATE SECTOR Background Paper

New Delhi, India 15 November 2010 ENGAGEMENT WITH THE PRIVATE SECTOR Background Paper DRAFT 2 (1 November 2010) B9 / 10 / 7.2

CONTENTS Acronyms and abbreviations... 3 1. Introduction... 5 1.1. Background...5 1.2. Purpose and structure...5 1.3. Definitions and key terms...6 1.4. Methodology...6 2. Strategic context...7 3. Private sector engagement in global health and MNCH... 9 3.1. PMNCH constituent engagement with the private sector...9 3.2. Examples of PMNCH engagement with the private sector...11 3.3. Examples of private sector participation in global health...11 3.4. Rationale for engagement...17 4. GHP engagement with the private sector... 19 4.1. Emergence of GHPs and engagement with the private sector...19 4.2. Typology of GHPs...20 4.3. Mechanisms of GHP engagement with the private sector...22 5. Implications for PMNCH... 27 Annex 1: List of consultations... 28 Annex 2: Examples of private sector participation in global health... 31 Annex 3: Case studies for GHP engagement with the private sector... 33 Annex 4: Bibliography... 47 Page 2 / 47 B9 / 10 / 7.2

ACRONYMS AND ABBREVIATIONS AMC Advanced Market Mechanism IMR Infant Mortality Rate ARVs Antiretroviral drugs IPA International Paediatric Association BD Becton, Dickinson & Co. JICA Japan International Cooperation Agency BMGF Bill and Melinda Gates Foundation J&J Johnson & Johnson CCM CIDA CII COI CSO CSR DFID DHI DMI F&B FIND Country Coordination Mechanism Canadian International Development Agency Confederation of Indian Industry Conflict of Interest Civil Society Organisation Corporate Social Responsibility Department for International Development Digital He@lth Initiative Development Media International Food and Beverage Foundation for Innovative New Diagnostics LSHTM London School of Hygiene and Tropical Medicine MDA WG Market Development Approaches Working Group MDG mhealth MMR MOU NGO P&G PDIP Millennium Development Goal Mobile Health Measles, Mumps and Rubella Memorandum of Understanding Non-governmental Organisation Procter & Gamble Product Development and Implementation Partnership GF GAVI GAIN GBC GDP GHC GHP GF GSK The Global Fund to fight AIDS, TB and Malaria Global Alliance for Vaccines and Immunisation Global Alliance for Improved Nutrition Global Business Coalition Gross Domestic Product Global Health Council Global Health Partnership Global Fund GlaxoSmithKline HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome R&D RBM RHSC TB THE UNFPA UNICEF USAID WEF WFP WHO Research and development Roll Back Malaria Reproductive Health Supplies Coalition Tuberculosis Total Health Expenditure United Nations Population Fund United Nations Children s Fund United States Agency for International Development World Economic Forum World Food Programme World Health Organization HMN IAVI IBLF ICT IFFIm Health Metrics Network International AIDs Vaccination Initiative International Business Leaders Forum Information and Communication Technology International Financing Facility for Immunization Page 3 / 47 B9 / 10 / 7.2

SUMMARY This paper is for information to the Board only and does not provide recommendations. Strategic context: With just five years left to achieve the Millennium Development Goals (MDGs), 2010 is a critical time for global leaders to intensify efforts to improve women s and children s health. Many of the world s most pressing problems, including addressing and achieving MDGs, are too complex for any one sector to address alone. As a result, there have been increasing calls from global leaders to increase collaboration with the private sector, such as the Global Strategy for Women and Children s Health. Private sector engagement in global health: Private sector engagement in global health is not a new concept. Many collaborative public-private initiatives in this sphere are well established and have increased in number and scale over the past 10 years. Engagement between the global health sector and the private sector contributes to improving public health outcomes by combining the skills and resources of various organisations in innovative ways. Most PMNCH partners actively engage with the private sector in the course of their existing activities. Global Health Partnership (GHP) engagement with the private sector: Other GHPs serve as comparator organisations in terms of the areas and mechanisms in which they engage with the private sector. GHPs can be categorised according to two dimensions: the strategic focus area (i.e. what they do); and governance or administrative arrangements. We have identified three broad types of GHP in terms of strategic focus: (i) knowledge, advocacy and coordination; (ii) financing; and (iii) product development. PMNCH most obviously fits in the first category and comparators in the same focus area and are hosted by WHO include Roll Back Malaria, Stop TB and Health Metrics Network. Our review of GHPs indicates that: (i) many GHPs studied engage with the private sector through private sector representation on the Board and/ or formal consultative or advisory bodies; (ii) knowledge, advocacy and coordination GHPs typically engage with the private sector through joint initiatives designed to raise awareness of causes of public health problems and sharing knowledge; (iii) most GHPs have policies or principles setting out the basis for their engagement with private sector. For example, GHPs hosted by WHO are bound by the overarching WHO principles and guidelines for engaging with the private sector. PMNCH engagement with the private sector: The private sector has not been systematically involved by PMNCH to date, although the Partnership has more recently made efforts to interact with the private sector and define a suitable value proposition for engagement. Although this paper does not seek to make specific recommendations in relation to PMNCH private sector involvement, it suggests that there is a good potential case for both (i) adopting a set of principles for engagement with the private sector; and (ii) actively considering areas where engagement could be beneficial in achieving PMNCH s objectives (and any related risks and issues). Page 4 / 47 B9 / 10 / 7.2

1. INTRODUCTION 1.1. Background With just five years left to achieve the Millennium Development Goals (MDGs), 2010 is a critical time for global leaders to intensify efforts to improve women s and children s health. Achieving the MDGs, and in particular the health MDGs 4, 5 and 6, is too complex for any one sector to address alone. The private sector is an important member of the global health community with its unique and broad competencies. It can play a key role in facilitating maternal, newborn and child health (MNCH) as well as other health outcomes. Outside of specific health involvement, the private sector provides enabling capabilities that support health, such as information technologies and wireless communications. As a result, there have been increasing calls from global leaders to increase collaboration with the private sector. PMNCH is also interested in exploring options for more systematically working with the private sector in support of the achievement of its goals (see Section 2 for more detail on the strategic context). In November 2009, the Secretariat commissioned Cambridge Economic Policy Associates (CEPA) to examine the engagement of the private sector across MNCH activities and its possible role in supporting the Partnership s mission and Priority Action areas. Following on from the paper developed by CEPA, Barbara Bulc (an independent advisor with extensive experience in public-private partnerships) was engaged by PMNCH to carry forward CEPA s work. She carried out extensive consultations with the Board, selected PMNCH members, and other external stakeholders. This work was developed into a paper and a presentation on opportunities for PMNCH engagement with the private sector. The presentation was delivered to the PMNCH Board at its eighth meeting (April 2010, Dhaka) by Board member Al Bartlett. Following the presentation and subsequent discussion, the Board agreed in principle to explore PMNCH s engagement with the private sector and specifically explore opportunities to engage with existing alliances such as mhealth and the World Economic Forum (WEF). The Secretariat was asked to develop two further papers for the ninth Board Meeting (to be held on 15 November 2010 in New Delhi): a Principles Paper for guiding PMNCH engagement with the private sector (for the Board to endorse or adopt the principles); and a Background Paper on mapping of the private sector engagement in the global health sector (for information to the Board). 1.2. Purpose and structure This document is the Background Paper and has been prepared with the support of CEPA and Barbara Bulc. Its purpose is to: outline the strategic context of private sector engagement in global health (Section 2); describe the rationale for private sector engagement and map existing engagement in the global health sector (Section 3); summarise mechanisms of engagement for comparator GHPs (Section 4); and summarise PMNCH s existing dialogue / interaction with the private sector and illustrate potential areas of engagement (Section 5). Page 5 / 47 B9 / 10 / 7.2

1.3. Definitions and key terms Key terms used in this paper are as follows. Private sector The private sector is defined as businesses (for-profit commercial enterprises), alliances/associations of businesses (which may themselves be not-for-profit), and company foundations that are not at arms length from the company. 12 Engagement Engagement with the private sector includes most types of involvement or collaboration. This includes strategic procurement and supplier relationship management, but excludes operational engagement in contractual / consulting appointments for the provision of products or services. Global Health Partnership (GHP) We define GHPs as partnerships and related initiatives whose activities and outcomes cut across more than one region of the world, and in which partners reach explicit agreements on health objectives; agree to establish a new (formal or informal) organisation; generate new products or services; and contribute dedicated resources to the program. 3 1.4. Methodology The paper has been informed by the following sources of evidence and analysis: Desk research and literature reviews to develop case studies on private sector engagement of key comparator health organisations (full bibliography in Annex 3). Interviews with subject experts (see Annex 1) including: o PMNCH Partners and Secretariat: PMNCH Board and Executive Committee members, Secretariat leadership, and other experts such as the World Health Organization (WHO) Department of Partnerships and UN Reform and the Office of the Legal Counsel. o Other organisations: representatives of other GHPs, industry, business alliances or coalition, and experts. 1 Based on this definition, this paper does not consider non-commercial private sector although in many cases findings would be applicable to it. It also does not consider PMNCH collaboration with other GHPs. 2 A foundation is not at arms length if it receives all or the majority of its budget from the company that established it and / or the founding company plays a role in the foundation s decision making process. 3 Adapted from World Bank definition: World Bank Operations Evaluation Department (1 August 2002), The World Bank s Approach to Global Programs: An Independent Evaluation. Page 6 / 47 B9 / 10 / 7.2

2. STRATEGIC CONTEXT Since the Board requested the Secretariat to develop these papers (in April 2010) the Global Strategy for Women s and Children s Health has identified key actions to be taken forward. Given this, it is important to frame the rest of the paper in the context of the Global Strategy and other recent developments. The Global Strategy aims to tackle MNCH challenges by setting out the key areas where action is urgently required to enhance financing, strengthen policy and improve service delivery. To be successful, partners (including the private sector) need to take coordinated action which recognises their different roles and comparative advantage. The strategy therefore calls on policymakers at local, national, regional and global level to: Encourage all stakeholders (including academics, health-care organisations, the private sector, civil society, health-care workers and donors) to participate and to harmonise their efforts. Work with the private sector to ensure the development and delivery of affordable, essential medicines and technologies for health. The key events this year that have sought to mobilise the engagement of the private sector in MNCH include: The UN MDG Summit (September 2010 in New York) brought together Heads of State and Government, along with the private sector, foundations, international organizations, civil society and research organisations, to kick off a major worldwide effort to accelerate progress on women s and children s health. The outcome document on MDGs adopted by the UN General Assembly by consensus, repeatedly recognised the role of many stakeholders, including the private sector, and called for increased involvement of the private sector and the need to enhance and strengthen public-private partnerships. 4 A number of satellite meetings were also convened during the summit, including: o A joint event on Accelerating Progress Towards the MDGs through Inclusive Business to rally business energy and expertise to help accelerate the development and scaling of Inclusive Business models to achieve the MDGs. 5 o The UN Global Compact convened by the UN Private Sector Forum chaired by the UN Secretary- General Ban Ki-moon, where over 300 Heads of State and Government, Chief Executive Officers, Civil Society Leaders and Heads of UN Agencies discussed actions that the private sector can take (individually and in collaboration with the public sector) to help address the implementation gaps to reach MDGs. o Advanced Development for Africa hosted the Women Connect for Health event, which brought together eminent personalities and world leaders including several First Ladies of various countries, CEOs of leading global ICT and mobile providers, health services providers, and visionaries in the campaign for greater access to and use of ICT, especially mobile technology, in order to improve health in Africa. The Improving Women s and Children s Health: Let s show we mean business event jointly hosted by the UN Foundation, International Business Leaders Forum (IBLF) and PMNCH which focused on exploring the ways in which the private sector can contribute to supporting the Global Strategy (September 2010 in London). The Pacific Health Summit 2010: Maternal and Newborn Health: The Crux of a Decent Humanity, with the agenda dedicated to MNCH and including private sector mobilisation for MNCH outcomes. The summit was jointly 4 UN General Assembly 65 th session agenda items 13 and 15, outcome document, item 23 5 Led by Business Call to Action, IBLF, Business Action for Africa, International Chamber of Commerce, UNDP, Global Compact, UN Office for Partnerships, and the Harvard Kennedy School Corporate Social Responsibility Initiative. Page 7 / 47 B9 / 10 / 7.2

partnered by the Bill and Melinda Gates Foundation, the Wellcome Trust, the National Bureau of Asian Research, and the Fred Hutchinson Cancer Research Center, with participation from leaders from academia, NGOs, health professionals, national and global policy makers (June 2010 in London). The Maternal and Newborn mhealth Initiative (MNMI) was also announced at the summit (joint initiative of the mhealth Alliance, PMNCH, BRAC, White Ribbon Alliance, PATH, Family Health International, GSM Association, and others). Page 8 / 47 B9 / 10 / 7.2

3. PRIVATE SECTOR ENGAGEMENT IN GLOBAL HEALTH AND MNCH Private sector engagement in global health and the MNCH sector in particular, is not a new concept, and many collaborative initiatives in this sphere are well established. In this section, we provide: an overview of existing engagement between PMNCH Partners and the private sector in MNCH and more generally; an overview of existing engagement between PMNCH at the Partnership level and the private sector in MNCH; details of case studies where the private sector is engaged in different aspects of MNCH. These case studies are drawn from six sectors and also from three business alliances; and observations on what these examples, the literature and CEPA experience and insight say about the rationale for engagement on the part of both public and private sector. 3.1. PMNCH constituent engagement with the private sector Many PMNCH members and partners actively engage with the private sector. The nature of engagement is summarised below for each existing PMNCH constituency. 6 Multilaterals Multilaterals including the WHO, The World Bank, United Nations Population Fund (UNFPA), and United Nations Children s Fund (UNICEF) are key members and partners of PMNCH. Over the last two decades, multilaterals have increasingly focused on engagement with the private sector, and as such, many activities between multilaterals and the private sector are relatively recent. Multilaterals now engage extensively with the private sector over a range of activities, such as resource mobilization, advocacy, networking and knowledge sharing. Joint implementation of initiatives is also a form of multilaterals engaging with the private sector, since multilaterals have both global and country-level presence which facilitates delivery. Variation in multilateral relationships with the private sector is based on the specific roles of the UN agency. For example, WHO as a normative/ policy-setting agency has a related set of specific constraints. The role of the private sector has also been recognised by the UN in order to further expand and strengthen collaboration. In 2009, following the fifth Secretary-General s Report to the General Assembly on Enhanced cooperation between the United Nations and all relevant partners, in particular the private sector, a resolution was adopted under agenda item 59, Towards Global Partnerships. 7 The resolution reaffirms the critical role of the private sector in supporting UN goals, and invites the UN organisations to seek to engage in a more coherent manner with private sector entities that support the core values of the UN. Organisations within the UN group should adhere to the framework outlined in Guidelines on Cooperation between the United Nations and the Private Sector (2009), and are encouraged to develop more specific guidelines in accordance with their particular mandates and activities. WHO has built on these and developed WHO Policy Framework for Engaging and Working with the Commercial Private Sector (March 2010). Both frameworks are comprehensive guidelines on private sector engagement. 6 Engagement for constituency members reflects activity outside members capacity as PMNCH members. 7 UN General Assembly sixty-fourth session, Second Committee, Agenda Item 59 (2009) Page 9 / 47 B9 / 10 / 7.2

Donors and foundations This constituency is generally made up of donor country governments (bilaterals) and charitable foundations. Organisations within this constituency have relatively advanced engagement in areas such as joint delivery and knowledge sharing. For example, the Bill and Melinda Gates Foundation (BMGF) financially supported an initiative with Merck which aims to respond to HIV/AIDS needs in Botswana. The United Nations Foundation, one of the main partners of PMNCH for leading the advocacy work on the Global Strategy, is also founder and host of mhealth Alliance. The donors and foundations studied have varying approaches to principles for engagement. Some organisations have significant experience in engaging with the private sector and have comprehensive principles defined (for example, the USAID Partnership Governance and Accountability Framework, which has also been adopted by GAIN). Others with less experience have basic principles addressed in Conflict of Interest policies. NGOs The NGO constituency is the largest in terms of numbers of PMNCH members. NGOs range from large, global NGOs such as World Vision, Save the Children and BRAC, to smaller country based groups such as the Zimbabwe Grace Trust or the Seattle Home Maternity Service and Childbirth Center. Organisations in the former category are more comparable with PMNCH in terms of influence and operations, hence we focus on larger NGOs. In general, NGOs operating globally have relatively broad and advanced engagement with the private sector, and have demonstrated innovation in both the activities engaged in and mechanisms for engaging the private sector. Resource mobilization is a core area of engagement, as the private sector can often account for substantial amounts of NGO funding. Advocacy, knowledge sharing,advisory and the provision of products and services are other areas in which NGOs engage the private sector. Many such NGOs also have principles for engaging with the private sector, though these vary in terms of objectives. Some principles are mandatory and pre-requisites for engaging (e.g. transparency ), whereas others are aspirations or best practice (e.g. build trust ). Healthcare Professionals and Academic and Research Institutions There are 22 members in the Healthcare Professionals constituency, including the International Paediatric Association, the International Federation of Gynaecology and Obstetrics, and the International Confederation of Midwives. The University of Aberdeen and the All India Institute of Medical Sciences (AIIMS) belong to the academic and research institution constituency. Healthcare Professionals have relatively little to moderate engagement with the private sector, and many do not have a strategic approach or formal principles for engagement. However, members within these constituencies have expressed interest in building on existing engagement with the private sector. Academic and Research Institutions have moderate to well developed partnerships with the industry in different areas. For example, the University of Aberdeen s Sixth Century Campaign is a major international initiative to raise funds for the University. By the end of the first phase in October 2004, more than 60 corporations had donated to the campaign. Page 10 / 47 B9 / 10 / 7.2

3.2. PMNCH exploration of engagement with the private sector As noted above, many of PMNCH s members already individually collaborate with the private sector at global, regional or national levels based on their individual approaches. However, the private sector has not been systematically/ formally involved by the Partnership as such. PMNCH has commenced efforts in interacting with the private sector and defining a suitable value proposition for their engagement. Some of the efforts to date are: Engagement with the mhealth alliance in advocacy and knowledge sharing, and other mhealth issues. Examples to date include joint events, joint development and leadership of MNMI, and working with partners to develop consensus on key interventions, decision tools for frontline health workers, inventory supply management and vital registrations (births and deaths). A draft proposal for collaboration and the detailed MNMI plan has been developed. Development of the Deliver Now India campaign (combines advocacy, communications and community mobilisation strategies to accelerate progress in achieving MDGs 4 and 5) with the White Ribbon Alliance for Safe Motherhood, India, Development Media International (DMI) and national media partners in Orissa India. Collaborative role in developing the Improving Women s and Children s Health: Let s show we mean business event co-hosted by the UN Foundation and International Business Leaders Forum (IBLF) in September 2010 in London. The event focused solely on exploring the ways in which the private sector can contribute to supporting the Global Strategy. Including private sector representatives in the planning of the Partners Forum in India on 13-14 November 2010 and having some private sector participants at the event to share their experiences in MNCH and also showcase their innovations in the Marketplace. A side event on 12 November, convened by IBLF in association with the Partners Forum, the Business & Community Foundation, and the UN Foundation to explore ways in which business and multi-sectoral partnerships can further contribute to the Global Strategy. In addition to that, co-organizing a technical meeting on 12 November on use of mobile phones and mobile technology to advance Global Strategy, in collaboration with mhealth Alliance and The Public Health Foundation of India. Meetings with alliances such as Global Health Council, WEF, GSM Alliance (GSMA), the Confederation of Indian Industry (CII), and companies from various industries (information communication technology, media, pharmaceutical, healthcare diagnostics and equipment, healthcare delivery, consumer goods, energy and mining, and banking) to advocate for support for the Global Strategy. 3.3. Examples of private sector participation in global health Private sector participation in health is summarised for both business and alliances, which are categorized as follows: Businesses six industry-specific groups (information technology; telecommunication, media; consumer goods; pharmaceutical; and healthcare delivery). Alliances three groups defined by mission / constituents (health, industry and general alliances). Illustrative examples of engagement are provided for each category. Additional examples are available in Annex 3. Page 11 / 47 B9 / 10 / 7.2

3.3.1. Businesses The engagement of businesses (existing and potential) in MNCH and broader health activities is summarized in six industry-specific categories as illustrated in Figure 3.1 below. These are: (i) information technology; (ii) telecommunication; (iii) media; (iv) consumer goods (including food and beverage companies); (v) pharmaceutical; and (vi) healthcare delivery (products and services). These six industries are potentially most strategically aligned with PMNCH (as a GHP focusing on advocacy) and well-positioned for involvement in MNCH activities in order to deliver better, global, public health outcomes. In particular: Better outcomes the technology and telecommunications industries facilitate better outcomes in driving more/ additional, improved, efficient, faster, or new/ innovative results. Global outcomes the telecommunications, media and consumer goods industries offer access to global logistics, operations and human resource networks, as well as large consumer bases. Public health outcomes the pharmaceutical and healthcare delivery (both products and services) industries have a direct impact on public health outcomes in their development of products, services and facilities. The examples chosen within each industry seek to illustrate advanced involvement in supporting health outcomes, and highlight scalable forms of engagement and/ or initiatives that could be replicated in MNCH. It is important to note that other industries are also valuable partners, in particular, the financial sector (banking, insurance, micro-finance), transportation and logistics, and extraction and mining 8, but were not studied for the purpose of this analysis. Figure 3.1: Business categorization by industry Media Consumer goods Telecommunications Pharmaceutical Information technology Healthcare delivery Better, global, public health outcomes Information Technology Information technology is a key part of effective health information and service delivery, data collection and monitoring for both patients and diseases. It can increase the absorptive capacity of developing countries by enabling tasks to be conducted quicker, cheaper and more effectively, and overcome health system barriers such as transport 8 Extraction and mining companies often have large workforces. In turn, the workforce health programs of such companies can have positive impacts on the workers themselves, but this would also be extended to dependants and communities to have an additional impact on improving health outcomes Page 12 / 47 B9 / 10 / 7.2

infrastructure (by sharing information online and hosting meetings/patient consultations virtually). Technology is also a driver for disseminating health education, knowledge sharing between healthcare professionals and organizations, training and development of health workers, and providing mobile health solutions. Better and more advanced information technology offers greater efficiency and productivity. Examples in this industry are Intel, Cisco, Infosys, SAP, and Microsoft. Box 3.1: Intel The Intel World Ahead Program increases access to relevant technologies and broadband infrastructure with 200 programs in more than 70 countries. It collaborates on efforts that use digital technologies to improve medical education and make PC adoption by healthcare workers easier, which can speed up and improve the training of new health workers. Intel has published a white paper on digital health (Intel Health IT Value Model for Developing Nations). Furthermore its Mailafiya program is a strategic program that harnesses ICT to increase access to health services for rural and under-served urban populations in districts surrounding Abuja. Telecommunications Globally, there are close to 5 billion mobile phones today, of which about 70% are in developing countries. Several mobile phone companies have undertaken groundbreaking work in global health to improve MNCH. Some have established dedicated health divisions (e.g. Vodafone, Orange, Ericsson, Grameen) to focus on development of sustainable applications and products for developing countries to improve health outcomes. Others have begun developing specific tools and initiatives for health (e.g. MTN, Bharti, Huawei, Telefonica, China Mobile). The wireless industry is trying to decrease gender gap in access to mobile phones, which leaves approximately 300 million women unable to connect to mobile networks today. Box 3.2: Vodafone The Vodafone Foundation has invested in 27 countries in which it operates, in both global and local social investment programs, and is a founding member of the mhealth Alliance. The Foundation spearheaded the Nompilo Community Caregiver Management Solution in South Africa to improve patient records and information access. Vodafone also recently announced the launch of a new Healthcare Solutions division to focus (among other things) on the development of affordable healthcare applications and products for developing countries alongside other companies such as Johnson & Johnson and Novartis. Media The Media industry, broadly including TV, radio, PR, advertising, online and social media can significantly impact awareness and public behaviour through advocacy at global, regional and local (country) levels in support of MNCH. At the global level this could be through large-scale campaigns, and at the regional and local levels, through targeted mass-media campaigns and capacity building. Examples include the BBC, MTV, CNN, Facebook, Google, Edelman etc. Page 13 / 47 B9 / 10 / 7.2

Box 3.3: MTV Networks International The Staying Alive Campaign is a partnership between MTV Networks International, UNAIDS, UNICEF and UNFPA, Now in its 11th year, Staying Alive has established itself as the largest and most effective mass media campaign on HIV/AIDS in the world. The Staying Alive program uses two approaches to disseminate its message. One is a multimedia educational component that uses on-air programming and digital platforms to spread awareness of the disease, its causes and prevention, leveraging celebrity involvement by appointing celebrity Ambassadors to champion the initiative s messages around the world and take a lead role in the initiative s programming. The other is the Staying Alive Foundation, a global public charity, which provides small grants to young people to help fund grassroots projects designed to stop the spread of HIV/AIDS, in order to maximize the campaign s visibility. Consumer goods (including food and beverage companies) Corporations in the consumer goods industry, particularly multinationals, have large consumer bases and as such, are ideal for contributing to health. Given they are often trusted household names with strong brands, consumer goods firms have used their products as a tool for advocacy, awareness raising, and driving public behaviour change. Some have designed special edition products dedicated to a cause to raise funds and others have donated goods. Companies have also used their extensive global supply chains to deliver health products to the public. Examples include Unilever, Procter & Gamble, DSM, Johnson & Johnson (J&J). Box 3.4: J&J J&J contributed cash and products to more than 650 philanthropic programs in more than 50 countries in 2009, with saving and improving the lives of women and children one of three areas of the company s focus. J&J partner with the Life Skills Development Foundation in Thailand on an early child care development program that promotes physical and psychological health and education for children. J&J also collaborated with Vodafone to develop a mobile platform to make its internet based information and education website for mothers (www.babycenter.com) available through mobile phones in developing countries. J&J made a major commitment of $200 million to suppor the Global Strategy over the next 5 years. Pharmaceutical The Pharmaceutical industry, both research and generic, provides essential products and technologies to improve MNCH. The Pharmaceutical industry has collaborated with the public sector in the development and production of affordable vaccines/medicines, significantly increasing access. Partnership with other industry sectors in initiatives to improve health outcomes, most notably mobile / communications and technology, have tremendous potential for scale-up. Examples include GSK, J&J, Merck, Sanofi Aventis, Novartis, Sandoz. Page 14 / 47 B9 / 10 / 7.2

Box 3.5: GlaxoSmithKline (GSK) Within products and services, GSK has invested over US$300m to develop a candidate malaria vaccine RTSS in partnership with the PATH Malaria Vaccine Initiative. It is also on track to be one the first companies to supply vaccines through the innovative financing mechanism of the Pneumococcal Advanced Market Commitment (AMC), led by GAVI and the World Bank. In research and knowledge sharing, GSK has launched a new open innovation strategy, which includes making 13,500 malaria compounds freely available to researchers. Healthcare delivery Private hospitals and medical facilities often account for the majority of frontline healthcare services delivered, and have a significant impact on the quality of MNCH services. Examples include Apollo Hospitals, LifeSprings Hospitals, Fortis Healthcare, and Aga Khan Hospitals. Medical devices companies are critical to the delivery of cost-effective and scalable solutions and interventions in MNCH. Examples include GE Healthcare, Siemens, and Philips. Medical diagnostic companies are equally vital in innovations in tests to detect and combat disease. Examples include Becton Dickinson and Perkin Elmer. Box 3.6: GE Healthcare Developing Health Globally is a scheme focussed on maternal and child health. Set up by GE Healthcare in 2004, it has a $40m commitment to improve access to quality healthcare in eleven countries in Africa, Latin America and Asia. GE Healthcare works in partnership with Ministries of Health to select hospitals for the programme, and subsequently improve facilities and increase capacity. When installation and training is complete, GE Healthcare employees monitor equipment use and impact, and provide coaching support to improve operations. The average investment at each hospital site is approximately $500k and the programme overall is expected to have reached 4.8 million people. 3.3.2. Alliances Alliances are categorised into three groups, those dedicated to the health sector, industry focused alliances, and other alliances with more general/ cross-cutting aims. Health alliances Health alliances have public health improvements at the heart of their objectives, though this objective is often sought to be improved in different ways (e.g. mobile services or technology) as the following examples illustrate. These alliances generally operate across the public and private sectors. Examples include the mhealth Alliance and DHI. Page 15 / 47 B9 / 10 / 7.2

Box 3.7: mhealth Alliance The recently formed mhealth Alliance, hosted by the UN Foundation, focuses on MNCH as a priority area to develop the potential of mhealth. Key activities include building a virtual global community of like-minded groups through a HealthUnBound virtual platform with HMN and many other partners, bringing thought leadership from the various stakeholder constituencies to bear on key barriers to mobile health, defining global enterprise requirements and technology architecture, finding sustainable business models to advance MDGs, and supporting the deployment of in-country trials to demonstrate improved health outcomes and value chains. Industry alliances Industry alliances bring together key players and stakeholders within given industries, with the unique ability to bring together key private sector organizations (often competitors) to work together towards common goals in health. Examples include the GSM Association (GSMA), International Federation of Pharmaceutical Manufacturers and Associations, and the Confederation of Indian Industry (CII). Box 3.8: GSMA GSMA represents the interests of the global mobile communications industry and spans 219 countries, unites nearly 800 of the world s mobile operators and more than 200 companies in the broader mobile ecosystem. GSMA s Mobile Planet programme leverages mobility to improve the lives of individuals across the developing world, bringing services to these markets in a socially responsible manner. One of the key aspects of the program is the Development Fund - GSMA works with mobile operators to accelerate mobile solutions for people living on under US$2 per day. Within the Fund, the mhealth initiative has supported three initiatives in Africa, Pakistan and Egypt. The Fund is looking across the health value chain to support sustainable projects that combine public and private sector efforts at public health interventions, and is exploring opportunities for the mobile operator community to engage in commercially viable and socially responsible projects. GSMA is also a founding member of the mhealth Alliance. General alliances These alliances operate across a range of industry sectors. They are often issue-specific, and have cross-cutting aims such as economic development or responsible business. Examples include the World Economic Forum (WEF), Global Health Council (GHC), International Business Leaders Forum (IBLF), and the Clinton Global Initiative. Box 3.9: World Economic Forum (WEF) WEF s Global Health Initiative aims to galvanise businesses across all industry sectors to take action to improve global health, in partnership with other stakeholders. WEF s broader portfolio of health activities is focused on areas where raising awareness and facilitating dialogue are critically needed, such as the Global Health Data Charter, Innovative Models in Healthcare Delivery, and Global Health Councils (e.g. Global Healthcare Systems, The Healthy Next Generations, Pandemics, Nutrition and new GAPs in development). Page 16 / 47 B9 / 10 / 7.2

3.4. Rationale for engagement The case studies above demonstrate that there is a good deal of engagement between the private sector and various entities that contribute to improving public health by combining the skills and resources of various organizations in innovative ways. Involving the private sector in ways that draw on the synergies between their activities and health requirements at the global and national levels could be beneficial for all stakeholders involved. 3.4.1. Incentives for the global health sector to engage with the private sector The core benefit of the global health sector working in collaboration with the private sector is to build capacity and innovate in areas where the private sector has a comparative advantage in terms of relevant expertise and experience. These may include: 9 Financial capacity Making commercial investments in private, market-driven health services, making community-level health investments, creating innovative insurance and financing mechanisms, pooling procurement, supporting micro-enterprise and providing philanthropic funding. Institutional and infrastructure capacity building health facilities, extending the use of corporate institutional and physical infrastructure and sharing expertise. Human resource capacity sharing staff through pro bono projects, supporting volunteer programs, and providing training/ capacity building and development. Public communication, advocacy and education capacity supporting marketing campaigns, providing technology and equipment to support learning, promoting causes through core business operations (e.g. branded products), supporting business leaders to speak publicly about health issues and sponsoring relevant events and forums. National policy coordination, planning and monitoring capacity contributing to consultations on the development and implementation of global and country level health policy and strategy, participating in events to contribute commercial perspective on health issues, and engaging in country coordinating mechanisms. For many organizations within the global health sector, the areas outlined above will be underpinned by contractual appointments for products and/ or services. This is valuable in itself, however increasingly, the global health sector is recognising the additional benefits for public health beyond contracting, through more strategic engagement, relationships and partnering. 3.4.2. Incentives for the private sector to participate in global health The motivation of the private sector to participate in working towards the MDGs (and global health) stems from three key drivers: 10 Investing in a sound business environment Most legal enterprises benefit from operating in stable and secure societies. They benefit from having access to a healthy and competent workforce and prosperous consumers and investors. Productive and competitive companies benefit from the existence of open, rule-based, predictable and non discriminatory trading and financial systems and a non-corrupt and well governed 9 Adapted from: Jane Nelson (2006), Business as a Partner in Strengthening Public Health Systems in Developing Countries (part of the Clinton Global Initiative An Agenda for Action series. 10 IBLF and UNDP: Business and the Millennium Development Goals: a Framework for Action, 2 nd edition (2008) Page 17 / 47 B9 / 10 / 7.2

economy. Failure to achieve the MDGs is likely to undermine some or all of these pillars of business success at both a national and international level. Managing direct costs and risks Challenges such as local environmental degradation, global climate change, HIV/ AIDS, ethnic conflict, and inadequate health and education systems, can add directly to the costs and risks of doing business. They can increase operating costs, raw material costs, hiring, training and other personnel costs, security costs, insurance costs and the cost of capital. They can create both short-term and long-term financial risks, market risks, litigation risks and reputation risks. The companies that understand and address these challenges can improve their risk and reputation management, reduce their costs, improve their resource efficiency and enhance their productivity. Harnessing new business opportunities Some of the world s most successful and innovative companies are developing new products, services, and technologies, and in some cases even transforming their business models, to address social and environmental challenges. They recognise that many developing countries, especially those with large populations and natural resources, offer long-term business opportunities. To these companies, helping to achieve the MDGs is not only a matter of corporate social responsibility, embedded in compliance, risk management and philanthropy, but also a matter of corporate social opportunity and social enterprise, embedded in innovation, value creation and competitiveness. Page 18 / 47 B9 / 10 / 7.2

4. GHP ENGAGEMENT WITH THE PRIVATE SECTOR Given PMNCH is a GHP, other GHPs serve as important comparator organizations in terms of the areas and mechanisms by which they engage with the private sector. This section: describes the emergence of GHPs and their engagement with the private sector provides a the typology of GHPs, in terms of what they do and how they are governed (this typology allows us to identify the most appropriate comparators for PMNCH); and summarises the findings of our analysis of how the private sector is engaged by different types of GHP. 4.1. Emergence of GHPs and engagement with the private sector As GHPs have emerged and developed over the last few decades, the role of the private sector has also been increasingly recognised. This shift in public and private relationships in global health is presented in Figure 4.1 below. 1970s partnerships between donor governments and recipient governments were common, however there was minimal collaboration between private and public sectors within the UN or international development systems. 1980s with the influence of neoliberal ideologies, initial polemics had given way to explorations of partnerships between governments, NGOs and industry. Some international organisations and donors recognised a greater role for the private sector in addition to contractual relationships for goods and services. 1990s given interagency competition and overlapping mandates, there were emerging and increasing concerns about effectiveness of the UN emerged with specific missions. These were perceived as more efficient, and included industry involvement. 2000s GHPs continued to grow and became an established part of the international development framework, with increased involvement of the private sector, philanthropic foundations, and NGOs. Innovative ways of partnering with industry emerged, for example, GAVI and the vaccine industry through AMCs, the Millennium Foundation and the travel and tourism industry, and Global Fund and the RED campaign. The emergence of several large GHPs has changed the way we address challenges of global public health. The UK s Department for International Development (DFID) conducted a mapping of GHPs in 2004, which identified 79 GHPs. 11 Since this list is not exhaustive and new GHPs have emerged since (e.g. UNITAID), the actual number of GHPs is likely to be significantly higher. A recent article in The Lancet reviewed over 100 disease specific GHPs. 12 11 DFID Health Resource Centre (2004): GHP Study Paper 1 Mapping Global Health Partnerships (2004) 12 The Lancet 2009 373: 2137 69 (2009), An assessment of interactions between global health initiatives and country health systems'. Page 19 / 47 B9 / 10 / 7.2

Figure 4.1: Shift in public and private relationships in global health partnerships13 Constituents of GHPs have different individual mandates, competencies, objectives and interests. However, their collaboration is based on shared health-creating goals, mutually agreed principles, and agreed division or labour. GHP stakeholders vary in terms of constituent organisations and key partners. However, in general, partners are likely to fall into one of eight key groups drawn from a mix of developed and beneficiary countries; multilaterals; donors and foundations; industry; research/ technical health institutes; academic organisations, NGOs / Community Based Organisations (CBO); and unaffiliated/ private individuals. 4.2. Typology of GHPs Our desk review of GHPs suggests that they can be categorised according to two dimensions: (i) strategic focus area (i.e what the partnership seeks to do); and (ii) governance or administrative arrangements. Strategic focus area A number of typologies have been suggested for classifying the different GHPs (Tidewater 2003; Buse 2004, DFID 2004), however given the particular focus of this paper, we use the following typology: Knowledge, advocacy and coordination GHPs that advocate for increased international and national response to specific diseases/ issues and facilitate policy development, research and knowledge sharing. GHPs in this category are PMNCH, Roll Back Malaria (RBM), Stop TB, and the Health Metrics Network (HMN). Financing GHPs that focus on resource mobilization, developing innovative finance mechanisms, and channelling funds or financing interventions at global and/ or country level. Examples of financing GHPs include the Global Fund (GF), GAVI Alliance, UNITAID, and the Global Alliance for Improved Nutrition (GAIN). 13 WHO Bulletin (2000) Policy and Practice Global public-private partnerships parts I and II Page 20 / 47 B9 / 10 / 7.2

Product development GHPs that research and develop new products, treatments and therapies, and support improved service access. Examples are the Foundation for Innovative New Diagnostics (FIND), the International Aids Vaccine Initiative (IAVI), Medicines for Malaria Venture (MMV), and Global Alliance for TB Drug Development. GHPs may conduct activities in more than one of the three areas defined above, however we have classified GHPs according to their primary goal / area of operation. Governance and administrative arrangements Governance and administrative arrangements vary between GHPs. They range from informal, virtual collaboration to those hosted by other organisations such as WHO or UNICEF (e.g. PMNCH is hosted by WHO, and GAVI was formerly hosted by UNICEF), whereas others are themselves formal legal entities in the form of independent organisations or foundations (e.g. GAVI is a Swiss foundation). Given that PMNCH is hosted by WHO, we focus here on governance and administrative arrangements in relation to WHO in particular. The Review of Health Partnerships and Collaborative Arrangements Involving WHO categorised partnerships in three key areas: 14 1.WHO programmes, initiatives, campaigns or networks that convene a variety of external partners to a common purpose, but have no independent governance arrangements. These partnerships are therefore governed by WHO and are part of WHO s budget and plans(e.g. Global Non-communicable Disease Network, World Alliance for Patient Safety). 2.Partnerships that have an independent governance arrangement, but whose secretariat is hosted and administered by WHO and, for which WHO provides a legal identity to the partnership (e.g. PMNCH and UNITAID). WHO has limited or shared control of the funds and / or workplans of these partnerships. 3.Partnerships or initiatives that do not have hosting arrangements and operate outside WHO. In these cases, WHO often makes significant technical contributions, contributes finance, or derives revenue, but such partnerships have their own governance structure (e.g. GAVI and the Global Fund). PMNCH within the GHP landscape As noted above, PMNCH is a knowledge, advocacy and coordination GHP, and it falls within the independent governance category of WHO partnerships. Figure 4.2 below illustrates the GHP landscape in terms of the two dimensions of GHP typology: strategic focus area; and governance and administrative arrangements. Given RBM, Stop TB and HMN are GHPs in the same typology as PMNCH for both dimensions, they serve as important comparators in the context of this paper, as does UNITAID (which is a financing GHP but hosted by the WHO). Examples of these organizations are therefore given particular consideration. 14 As defined in WHO (2008) Status of Health Partnerships and Collaborative Arrangements Involving WHO Analytical Review. Page 21 / 47 B9 / 10 / 7.2

Figure 4.2: PMNCH within the GHP landscape GAIN Knowledge, advocacy and coordination HMN Stop TB RBM PMNCH World Alliance for Patient Safety Global Health Workforce Alliance Global Fund UNITAID GAVI Finance FIND Global Alliance for TB Drug Development IAVI MMV Product development Governed by WHO Hosted by WHO (independent governance) Outside of WHO 4.3. Mechanisms of GHP engagement with the private sector As outlined above, the GHPs that are most comparable to PMNCH are primarily RBM, Stop TB, HMN and UNITAID; although others such as GAVI, GF, GAIN, IAVI, and FIND, also serve as useful points of reference. We present here our findings of a review of the engagement of each of these GHPs with the private sector. The full case studies are attached in Annex 3. We have considered this engagement under categories as follows: Engagement in delivery of strategic focus area. The nature of this engagement is typically determined by what the GHP is seeking to do. For example, private sector involvement in product development GHPs is first and foremost in the form of research partners seeking to deliver defined research outputs, whereas advocacyfocused GHPs might be expected to engage with the private sector more in PR, communications, and advocacy. Governance and advisory. This refers to whether and the extent to which the private sector is engaged with the governance of the GHP. It includes whether they play an advisory role and / or have full voting rights; whether the private sector is a formal constituency (and private sector Board Members are therefore representatives ); or whether the GHP seeks involvement of eminent individuals with private sector skills/ expertise (but who are not representing a company or constituency). Resource mobilization. Whether the private sector participation is involved with resource mobilization for the GHP itself (i.e. the Secretariat as opposed to resource for activities in the strategic focus area e.g. resource mobilization for MNCH at the country level would be part of the advocacy). Page 22 / 47 B9 / 10 / 7.2

Table 4.1 provides summary information for the case study GHPs under each of these categories. Key points to note from this review are as follows: The types of engagement in the strategic focus area for knowledge, advocacy and coordination GHPs are typically through joint initiatives designed to raise awareness of causes and share knowledge. A number of GHPs have private sector representation on the Board and / or formal consultative bodies. Most GHPs have explicit policies or principles setting out the basis for their engagement with private sector. For example, GHPs hosted by WHO are guided by the over-arching principles detailed in the WHO Policy Framework for Engaging and Working with the Commercial Private Sector as well as the Guidelines on Engaging the Commercial Private Sector. Moreover, all WHO hosted partnerships are subject to WHO s policy on conflict of interest (COI) for experts and staff. Some GHPs are in the process of developing COI principles for their Boards, based on WHO models. Other GHPs appear to have varying approaches to principles for engagement. GAIN has adopted the USAID framework; GAVI and Global Fund have referred to private sector engagement in COI policies; and IAVI and FIND do not have principles available on their websites. Page 23 / 47 B9 / 10 / 7.2

Table 4.1: Potential areas for PMNCH engagement with the private sector GHP Strategic area of focus Other (governance / advisory and resource mobilisation) Knowledge, advocacy and coordination RBM There are several crucial areas where the private sector contributes: sharing knowledge, expertise and implementation skills in delivering products and programmes supporting effective supply and efficient distribution of drugs, diagnostics, LLINs and other interventions against malaria; and the business mindset with its emphasis on good management practices and tangible results Private sector constituency has two Board members, Private Sector Delegation to the Board with a subset of 17 companies and IBLF as Focal Point coordinating the constituency, funded by a small constituency fee. All RBM constituencies sign Conflict of Interest Policy and Procedures Representatives participate in Task force, Committees and Working Groups and have web portal and newsletter. HMN HMN primarily works with the private sector in knowledge sharing and coordination: Worked with Googlemaps to plot all healthcare centres in Phnom Phen to communicate shortest routes to hospitals Developing HealthUnBound ( Hub ), an online meeting place for cooperation on Health Information Systems with the mhealth Alliance and other partners. No formal private sector constituency Chairman of Board is from private sector Stop TB Stop TB engages the private sector in two key global initiatives: Global Drug Facility (GDF) works with anti-tb drugs / diagnostics manufacturers and other partners to expand access to / availability of quality products Research movement engages TB researchers to increase the scope, scale and speed of TB research e.g. the joint research program with GSK. Private sector constituency has one corporate business sector Board representative, representing corporate health and non-health partner constituencies. Private sector participate in Board committees and working groups Private sector provides financial and other resources to support Stop TB mission All GDF partners follow Founding Principles for Governance/Financing, Application/Review, Procurement and Monitoring Page 24 / 47

GHP Strategic area of focus Other (governance / advisory and resource mobilisation) Finance Global Fund Works with the private sector to attract and disburse additional resources to prevent and treat HIV / AIDS, TB and malaria to ensure cost effective and efficient procurement of core health commodities and service delivery through core areas: cash contributions, provision of goods and services such as Voluntary Pooled Procurement mechanism, assistance in program implementation, in country coinvestments, and governance. Private sector constituency with 60 companies (GBC as Focal Point) and representation in Country Coordination Mechanism One private sector Board representative with full voting rights and one Alternate member, participating in Board comitees and working groups Examples of cash contributions include over $150 through the private sector Product(RED) campaign, 30 $ million from Chevron for country programs and $6.5 million in pro-bono services in 2006, from VH1 Publicis Group, Getty Images, and AKQA GAIN GAIN Business Alliance unites food producers and is a global focal point for private sector strategies against undernutrition. GAIN partners with businesses to ensure delivery of quality, affordable and accessible food to those most at risk of malnutrition. UNITAID UNITAID finances procurement of drugs and diagnostics to improve access to appropriate, affordable medicine in developing countries. Financed the creation of an independent Medicines Patent Pool Foundation which aims to facilitate access to intellectual property relating to these products. GAVI GAVI works with the developing and industrialized country vaccine industry to purchase vaccines using innovative financing tools such as AMCs and IFFIm. GAVI s private philanthropy team works with the private sector to amass additional funds for immunization. One private sector Board member and one private individual Board member No private sector members on Executive Board Research and generic pharmaceutical industry as members of Consultative Forum. Constituencies for both developing and industrialised country vaccine industry One Board member representing each of developing and industrialised country vaccine industry and nine independent individuals as Board members, all of whom with full voting rights. Page 25 / 47

GHP Strategic area of focus Other (governance / advisory and resource mobilisation) Product development IAVI The IAVI scientific team works with over 40 academic, commercial and government institutions to develop and assess candidate HIV vaccines and advance policies. For the private sector, examples include large multinational and small biotech companies such as GSK, Pfizer, BD, Algonomics, Elevation Biotech, Strand Life Sciences and Theraclone. FIND Works with private sector companies to improve diagnosis of TB. For example: o with Eiken for diagnosis in remote areas with limited testing equipment. o with BD for diagnosis in HIV patients. Four individuals with private sector expertise as Board members Private sector participation in Advisory Committees Several advocacy and fundraising initiatives with the private sector (eg. Providing innovation fund grants, research fellowships etc.) Constituency of commercial partners Current chairman holds several directorships in private sector firms and two additional Board directors with private sector expertise Page 26 / 47

5. IMPLICATIONS FOR PMNCH Although this paper does not seek to make specific recommendations in relation to PMNCH private sector involvement there a number of implications of the analysis. These are as follows: Compared to other knowledge, advocacy and coordination GHPs, PMNCH has relatively little private sector engagement in: o its strategic focus area (i.e. knowledge, advocacy and coordination); and o advisory or governance. More recently, there are increasing number of areas where PMNCH has begun to explore engagement with private sector actors (see Section 3.2), without an explicit policy or strategic approach to the engagement. Given these observations, we think that there is a good potential case for both (i) adopting a set of principles for engagement with the private sector and (ii) actively considering areas where engagement could be beneficial in achieving PMNCH s objectives. Figure 5.1 provides an overview of potential activities where it might be possible for PMNCH to engage with the private sector (within the strategic focus area and broader areas as defined in Section 4.3) based on the review of other GHPs. Figure 5.1: Potential areas for PMNCH engagement with the private sector (illustrative examples) Page 27 / 47